Nephrectomies for Non-neoplastic Disease

Dissection of the nephrectomy specimen is essen-tially the same for neoplastic and non-neoplastic diseases. Before beginning the dissection, try to establish from the patient’s clinical history whether fresh cortical tissue should be taken for immunofluorescence studies or electron micros-copy. Evaluate the kidney, the hilum, and the perinephric fat as three separate compartments, using the guidelines of dissection given earlier. When the specimen shows some modification (e.g., the absence of a perinephric soft tissue compartment), simply alter the dissection ac-cordingly. Some pathologists may prefer to evaluate the texture of the cortical surface by stripping the capsule from the fresh specimen, and this can be done before the kidney is sec-tioned and fixed.

If calculi are identified during the dissection, submit some for chemical analysis if indicated. Because the macroscopic findings often provide crucial clues to the pathologic process involv-ing the kidney, describe each component of the kidney individually and systematically (see Table 33-1).